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LEARNING OBJECTIVES
CMV IN IMMUNO COMPETENT PATIENTS
CMV IN IMMUNO COMPROMISED PATIENTS
CMV IN PREGNANT WOMEN
KEY POINTSIN HIV CMV IS REACTIVATION OF LATENT INFECTION
HIV AND CMV COINFECTION – RAPID PROGRESSION OF HIV
CD4 - <50 – CMV IS ACTIVATED AND DISSEMINATED
IN PREGNANCY ONLY PRIMARY INFECTION CAUSES IN VITRO TRANMISSION
NEONATES, INFECTED IN UTERO - RASHES, HEPATITIS, GASTROENTERITIS AND A ORGAN SPECIFIC MALADIES.
SURVIVORS – HEARING LOSS, VISION IMPAIRMENT AND MENTAL RETARDATION.
IN IMMUNO COMPETENT – FLU LIKE SYNDROME
AND REMAIN LATENT LIFE TIME
Human Cytomegalovirus
herpesvirus
betaherpesvirinae subfamily
CMV infected cells may become enlarged (cytomegalia), showing intranuclear inclusions.
Virus StructureEnveloped,
slightly pleomorphic
Spherical 120 – 200 nm in
diameter
CapsidEnvelope
Tegument Genome
double stranded DNA per virion
TRANSMISSION
Transmitted through infected bodily fluids that come in contact with hands
and then are absorbed through the nose or mouth of a susceptible
person.
CMV may be shed in the bodily fluids urine saliva bloodsemen
breast milk
The shedding of virus- intermittent
- without signs-without causing symptoms.
CMV infection High-risk groups:
(1) infection to the unborn baby during pregnancy
(2) infection to people who work with children
(3) immunocompromised person:
a) organ transplant recipients b) human immunodeficiency virus (HIV)
C)undergoing hemodialysisd) patients with cancer
The primary infection presents as mononucleosis-like syndrome which soon resolves.
Most of them asymptomatic for life.
CMV IN IMMUNO COMPETENT PERSONS
IN PREGNANCY WHEN A WOMEN WHO HAS NEVER HAD CMV INFECTION BECOMES INFECTED WITH CMV,
THERE IS A POTENTIAL RISK THAT AFTER BIRTH THE INFANT MAY HAVE
CMV-RELATED COMPLICATIONS
IN PREGNANCY
NEONATES, INFECTED IN UTERO - RASHES, HEPATITIS, GASTROENTERITIS AND A
ORGAN SPECIFIC MALADIES.
THE MOST COMMON OF WHICH ARE ASSOCIATED WITH HEARING LOSS, VISUAL
IMPAIRMENT, OR DIMINISHED MENTAL AND MOTOR CAPABILITIES.
NEONATES
Primary infection - rare in HIV as most have been exposed to CMV
Latent CMV infection is activatedin advanced HIV disease.
CMV IN HIV INFECTION
CMV IN HIV retinitis
oesophagitis encephalitis
myelitis radiculopathy
colitis pneumonitis
adrenalitispancreatitis
CMV Retinitis
small floaters foggy or blurred vision
loss of central or peripheral vision
routine exam when the infectious process is early and located in the
peripheral retina
loss of vision
retinal detachment
CMV – COFACTOR IN THE PROGRESSION OF HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1)
DISEASE.
PROGRESSION
Laboratory tests
CMV antibody - paired serum samples
1) ELISA 2)fluorescence assays 3)indirect hemagglutination4)latex agglutination
A virus culture
Tissue biopsy for culture
CMV blood culture ("buffy coat" culture)
CMV urine culture
CMV sputum cultures
ANTIGEN
CMV shell vial (a method of determining the presence of CMV antigens)
BIOPSY
Biopsies of organs likely to be infected with CMV
Treatment
First line:ganciclovir, powder for injection, 500
mg in vial Adults: 5 mg/kg i.v twice a day for 14-21
days
Second line:foscarnet, solution for injection, 24
mg/ml 250 ml, 500 mlAdults: retinitis; 90 mg/kg i.v daily for
14-21 days for CMV Adults: CMV oesophagitis; 90 mg/kg i.v
twice a day for 14-21 days
Maintenance
First Line:ganciclovir, capsules, 250 mg
Adults: 1 g orally three times a day
Second Line:ganciclovir, powder for injection, 500 mg
in vialAdults: 5 mg/kg i.v daily
Third line:foscarnet, solution for injection, 24
mg/ml 250 ml, 500 mlAdults: 90 mg/kg i.v daily
PROPHYLAXIS
Primary prophylaxis is generally not recommended because of cost concerns,
inconvenience and the potential for development of resistance
MAINTAINENCE
CD4+ cell counts > 100 for > 3 months as a result of potent ART